Elsa Sandoval-Anguiano of East Palo Alto comforts her son, Damian Anguiano, 4 years old, while he receives the measles, mumps, rubella, varicella vaccine at the Kaiser pediatric immunization clinic in Redwood City on Friday. With the Disneyland measles outbreak expected to grow, Kaiser is sending phone notices to patients with advice on what to do if someone is sick. less

Elsa Sandoval-Anguiano of East Palo Alto comforts her son, Damian Anguiano, 4 years old, while he receives the measles, mumps, rubella, varicella vaccine at the Kaiser pediatric immunization clinic in Redwood ... more

Photo: Liz Hafalia / The Chronicle

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Measles outbreak changes game for Bay Area hospitals

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With the Disneyland measles outbreak expected to grow in the coming weeks, Bay Area hospitals and doctors’ offices are preparing for new cases and a flood of questions from patients worried about getting sick.

Health care providers who have never seen a case of measles also are being trained on how to recognize the illness and what to do with patients who show up in clinics or emergency rooms with suspicious symptoms.

So far, 68 cases of measles have been reported in California this year, the bulk of them in people who visited — or had contact with someone who visited — two Disney theme parks in Anaheim just before Christmas. As of Friday, there were nine cases in three Bay Area counties: five in Alameda and two each in San Mateo and Santa Clara.

Public health experts said those numbers will climb; nine new cases were reported statewide from Wednesday through Friday this week. Measles is incredibly infectious for people who haven’t been vaccinated, and the incubation period can be as long as three weeks.

“Unfortunately, we are off to a bad start in 2015,” said Dr. Gil Chavez, deputy director of the Center for Infectious Diseases with the California Department of Public Health, in a teleconference with reporters earlier this week. “Clearly from this particular outbreak we can anticipate additional cases. If we can get people who are not vaccinated to get vaccinated, that would be super helpful.”

In California, roughly 90 percent of schoolchildren are vaccinated, but in pockets around the state, including the Bay Area, immunization rates are much lower, leaving many children vulnerable to illness.

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Complicating the problem is the fact that measles has been so uncommon for so many years that many people have never seen a case and don’t know what to look for, delaying diagnosis and treatment. Some people may be sick and not know it, going out in public and potentially exposing others to measles when they should be isolating at home.

The most important message to the community is to get vaccinated, doctors and public health officials say. Parents who have put off vaccinating their children should do it now, and anyone who doesn’t know his or her vaccination status should talk to a doctor about whether to go in for a shot.

“Families or parents who have chosen for whatever reason not to have their children immunized, it may be time to go back and have another talk with their doctor about that choice,” said Dr. Cora Hoover, director of communicable disease control and prevention for the San Francisco Department of Public Health.

Providers like Kaiser are sending notices to patients on where to get vaccinated and what to do if they think someone is sick. For starters, they say, don’t go straight to the doctor’s office, where one sick child could expose a waiting room full of kids to the virus.

The measles shot — which may also include a vaccine against the viruses that cause rubella, mumps and varicella, or chickenpox — is given in two doses, one at 12 to 15 months, and one before kindergarten. The first dose provides about 95 percent protection from measles, and the second dose bumps that up to 99 percent.

The vaccine is required for entrance to school, but parents can request an exemption, called the “personal belief exemption,” if they prefer not to immunize their children. The exemptions are controversial and have created “hot spots” of vulnerable children who have no protection from measles and other vaccine-preventable diseases.

Many parents who file exemptions are under-vaccinating their children, meaning their kids get some vaccines but not others, or the parents immunize their kids on a slower schedule than the one recommended by public health officials.

“This situation just really stresses the importance of immunizations and getting them timely,” said Dr. Jeffrey Silvers, an infectious-disease specialist at Sutter Health’s Eden Medical Center in Castro Valley. With “this disease, in an unvaccinated population, one person causes somewhere between 12 and 18 other people to get sick. It’s an extremely contagious disease.”

Public health officials have been able to get the vaccination status of 34 people infected in the current outbreak — 28 of them had not been vaccinated, including six infants who were too young to get the first shot.

People with measles often will have mild symptoms at first, including a runny nose, cough and watery eyes. They may have a low-grade fever. After several days, they will get a distinctive rash that starts on their forehead and spreads down their face and across their chest and limbs. They’ll often get a high fever at that time. The rash isn’t usually itchy or painful, but it takes about a week to go away.

There’s no specific treatment for measles and most people will fully recover. But it can lead to pneumonia and occasionally encephalitis, or swelling of the brain. And it can cause death in about one or two of every 1,000 people who get it.

In the current outbreak, 25 percent of those infected have been hospitalized, according to the state public health department. There have been no deaths.

The vaccine can have side effects, including fever, mild rash and swelling of the glands. About one in 2,500 to 3,000 children have a fever-induced seizure from the vaccine.

“These vaccines are not perfect. But they are so much better than what the state was like before we had them,” Silvers said. “What we have now is a generation of parents who never saw the childhood diseases that my parents saw. They don’t understand how many kids died, how many kids had permanent brain damage from measles. Kids need to be vaccinated.”